Social distancing and lockdown due to COVID-19: Impact on sleep and mood of adolescents

Ruchi Singh; Sunil Chouhan; Ragini Shrivastava; Nirendra Kumar Rai; Silvya Isac

doi:10.4103/jnsm.jnsm_81_21

PERSPECTIVE

Year : 2022 | Volume : 5 | Issue : 3 | Page : 313-316

Social distancing and lockdown due to COVID-19: Impact on sleep and mood of adolescents

Ruchi Singh¹, Sunil Chouhan¹, Ragini Shrivastava¹, Nirendra Kumar Rai², Silvya Isac¹
¹ Department of Physiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
² Department of Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Date of Submission	09-Jul-2021
Date of Decision	09-Mar-2022
Date of Acceptance	18-Apr-2022
Date of Web Publication	08-Jul-2022

Correspondence Address:
Ruchi Singh
Department of Physiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnsm.jnsm_81_21

Abstract

The unprecedented situation of countrywide lockdown with closure of physical schools, social distancing, and home confinement which arose due to COVID-19 pandemic had a significant impact on the sleep and mood of all age groups. Adolescence is the age of transition from childhood to adulthood. Students in this phase are anxious with planning for future and thus fall an easy prey to unhealthy lifestyle including irregular sleep cycle and eating habits. Freedom to follow self-decided sleep schedule with extensive use of digital media and sedentary lifestyle during the pandemic further added to the trend of unhealthy lifestyle among them. This perspective is aimed to explore the effect of nationwide or regional lockdowns enforced for curtailment of COVID-19 infection on the mood and sleep habits of adolescents. There were some positive as well as negative impacts on the sleep quality and mood of adolescents. Although home confinement gave a lot of opportunities to follow own sleep schedules and eating habits such as those on weekends or vacations, it also increased the separation stress from their peers, anxiety and fear of disease, erratic sleep schedule, and screen time among adolescents.

Keywords: Adolescents, irregular sleep schedule, lockdown due to COVID-19 pandemic, mood, sleep quality

How to cite this article:
Singh R, Chouhan S, Shrivastava R, Rai NK, Isac S. Social distancing and lockdown due to COVID-19: Impact on sleep and mood of adolescents. J Nat Sci Med 2022;5:313-6

How to cite this URL:
Singh R, Chouhan S, Shrivastava R, Rai NK, Isac S. Social distancing and lockdown due to COVID-19: Impact on sleep and mood of adolescents. J Nat Sci Med [serial online] 2022 [cited 2022 Aug 11];5:313-6. Available from: https://www.jnsmonline.org/text.asp?2022/5/3/313/350305

Introduction

Sleep is known to play a crucial role in healthy developmental process. Sleep debt and insufficient sleep have not only short-term deleterious effects on mood, cognition, and performance but also have long-term health consequences in the form of dyslipidemia, hypertension, Type 2 diabetes, etc.^[1] However, adolescents around the world suffer from sleep deprivation.^[2] Researchers have reported not only a shift in sleep phase of adolescents but also have described adolescence as a period during which individuals face affective challenges.^[3],[4] The recent outbreak of COVID-19 pandemic has forced the entire world to lockdown and to follow the norms of social distancing. In view of this, schools have been closed since the start of the pandemic and have adapted to remote online methods of teaching.^[5] Although strict social distancing was to some extent able to curtail the spread of COVID-19, it greatly impacted the mental health including that of adolescents. Uncertainty about the time for school closures and social distancing has led to unknown stress, anxiety, depression, and sleep disruptions among this section of our society. With the present review, we intend to put forward the impact of COVID-19 on the mood and sleep of adolescence.

Sleep Deprivation among Adolescents

Researchers, globally, have found that adolescents receive less than the recommended 9 h of sleep.^[3],[6],[7] More than 80% of adolescents are sleep deprived, with almost 26.6% receiving <6.5 h of sleep.^[3],[8] Insufficient sleep and irregular sleeping patterns, especially on weekdays and weekends, not only have an impact on their physical health, but also it affects their mental health as well as academic performance.^[3],[8],[9] Early morning school along with the shift in sleep phase of adolescents has been considered the leading cause of sleep deprivation among adolescents apart from several other factors.^[3] The “Healthy People 2030” has carried forward “sleep health” as one of the agenda with the goal to “improve health, productivity, well-being, quality of life, and safety by helping people get enough sleep.”^[10] One of its objectives is to increase the proportion of high school students and children getting sufficient sleep.^[10]

Effects of Sleep Deprivation

The neurobiological change in sleep–wake system of children with their transition to adolescence causes an almost 2 h of shift to a later timing. This postpones adolescents' sleep–wake cycles, making it difficult for adolescents to fall asleep before 11 PM.^[11] Almost 7% of adolescents suffer from delayed sleep phase syndrome (DSPS), a circadian rhythm disorder.^[12] In DSPS, there occurs a shift in sleep schedule, though the sleep architecture remains almost normal. Individuals with DSPS prefer going to bed late after 12 in midnight and wake up late in the morning.^[13] However, due to early morning college/school schedule during routine days, adolescents suffer from unavoidable sleep curtailment leading to sleep deprivation. Sleep deprivation has widespread effect on mood, academic performance, increased chances of accidents as well as substance abuse. A recent study suggested that social jet lag is not only restricted to adolescence but also is seen as early as 4–11 years aged children. Meeting the social demands along with early school timings creates a sleep debt among them leading to irregular patterns on weekdays and weekends.^[14] On weekends, almost 90% of adolescents try to catch up with the sleep debt accumulated through the weekdays, thus leading to irregular sleep pattern [Figure 1].^[15]

Figure 1: Schematic representation to show the impact of sleep phase shift on night sleep duration among subjects with delayed sleep phase syndrome. (a) Normal night sleep; (b) delayed sleep phase if uninterrupted; (c) Sleep phase if interrupted due to morning school; (d) Prolonged sleep phase on weekends

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Daytime sleepiness due to insufficient sleep is one of the main factors for poor academic performance. Adolescents either miss the morning school due to their inability to get up in time for school or are sleepy during the classes. Academic performance has shown to have a positive correlation with total sleep time as well as school attendance.^[3] Students with insufficient sleep have reported to achieve poor grades.^[16] Mood disturbances are also a known effect of sleep deprivation. Depression has shown to have a bidirectional relationship with sleep lack.^[17] Wolfson and Carskadon have reported that teenagers getting lesser than 6 h of sleep or those having an irregular sleep schedule on weekdays and weekends with a discrepancy of >2 h report higher symptoms of depression.^[18] Sleep disturbances have also been reported to be associated with anxiety disorders. However, the direction of association has again not been clarified.^[19] A bidirectional association between mood and sleep is evident as stress, mental aggression, and sadness increase with increasing sleep deprivation. Further, anxiety as well as stress both lead to arousal, agitation, and increase in alertness, thus Effecting sleep. Reduction in alertness due to insufficient sleep is also associated with drowsy driving and increased substance abuse.^[16],[20]

Several observational studies have shown that shifting the early morning schools a bit may improve the behavior and health of our adolescents. Students in evening school shifts of the same school have shown to have greater total sleep time, better academic performance, and less daytime sleepiness than the students of morning shift.^[21] Commuting distance to catch up the morning school further increases sleepiness among the students of morning schools.^[22] Delaying the school start time by 50–65 min has shown to increase sleep duration by 40–43 min, with reduction in the weekend night sleep duration suggesting less accumulation of sleep debt over the weekdays.^[23]

Lockdown as a Natural Experiment for Sleep Pattern and Mood

Nationwide lockdowns amid COVID-19 in several countries gave an opportunity for natural experimentation to study the sleep status among adolescents. Closure of physical schools and transition to remote online teaching modality was a perfect opportunity for adolescents to sleep according to their natural sleep homeostasis without any imposed bedtime and wake-up time for catching up on the morning school. A study on 45 adolescents reported an improvement in their sleep quality as well as duration. However, a delay of about 2 h in the sleep schedule was observed.^[24] Sleepiness was reduced in 78% of adolescents during online classes amid the pandemic, and daytime alertness was improved. Thus, the pandemic gave an opportunity to adolescents to follow their natural delayed sleep schedule in a feasible and affordable environment.^[24] However, this study did not use any objective measure of sleep and they also did not comment on the mood of their participants.

Home confinement during lockdown with disruption of social interactions also has an impact on the mood of the adolescents. Zhou et al., in their survey among 8079 Chinese adolescents aged 12–18, have shown a high prevalence of depression (43%), anxiety (37%), and combined depression and anxiety (31%) compared to adults during the COVID-19 outbreak.^[25] Reduced physical activity with home confinement, increased screen time, irregular sleep patterns, and less appropriate diet due to school closures similar to that during vacations lead to weight gain and reduced cardiovascular health.^[26],[27] These negative behaviors are expected to increase when there are restrictions to interaction with peers and friends with almost nil outdoor activities. Additionally, the fear for their family members, going out on a job of getting infected by Covid-19 and it's consequences to an extent of losing their dear ones' could have a distressing impact on the mental health of adolescents.^[27] A study among Palestine adolescent population has also reported >9 h of sleep among 69.7% of adolescents with reduced physical activity and increased screen hours in 74.7% of adolescents.^[28] 72.7% of adolescents reported staying at home as a common stressor, and 77.5% considered being away from friends a cause of stress. Thus, reduced physical activity and increased sedentary behaviors may negatively impact adolescents' physical as well as mental health.^[28] Zhou et al. found the prevalence of insomnia to be 23.2% among adolescents, which was much higher than the prevalence of insomnia among US (9.4%) adolescents in the absence of epidemic.^[25] They also reported poor sleep quality, increased sleep disturbances, later bedtimes, and increased sleep times among adolescents. The increased school free hours, poor sleep habits with staying up late due to increased mobile use, playing games, online shopping, etc., were considered probable causes for the poor sleep quality and insomnia. The poor sleep hygiene practices without any imposed wake-up timings due to school closures led to reduction in sleep quality of adolescents. Lack of knowledge about COVID-19 was also associated with increased insomnia, stress, and anxiety.^[25] A recent study has shown that sleep debt and social jet lag were significantly reduced during lockdown, thus the students had somewhat homogenous sleep behavior with less discrepancy in bedtime on weekdays and weekends, with 50% of the participants reportedly having sleep schedules similar to that on weekends.^[29] Although, wake-up time was still different on weekdays and weekends even during the lockdown.^[29] However, 25.7% of participants reported daytime naps, 37.1% reported increased sleepiness, and 31.4% reported discontinuous sleep during the lockdown.^[29] Although the authors in this study did not register much-increased screen time, daily routine during lockdown was comparable to the weekend routines before lockdown, and none of the participants reported the same sleep duration before and during the lockdown.^[29]

Conclusion

Through decades, researchers and policymakers are experimenting and searching for ways to deal with the epidemic of insufficient sleep among adolescence. Nationwide lockdown due to Covid-19 pandemic was a wonderful opportunity for the adolescents to follow a sleep routine of their choice with minimal restrictions but it also lead to increase in stress, anxiety, and depression primarily due to the pandemic itself and secondly due to physical separation from peers, curtailment of outdoor activities, more parental interference etc.

Increased screen time with unmonitored hours of access to the Internet came up as a double sword which, on the one hand, helped them to remain updated with their schoolwork, but on the other hand, they used it late night for socializing, shopping, and for playing games. During the pandemic, adolescents were though able to get enough sleep, but as they followed irregular sleep schedule with increased napping, late bedtime, and wake-up time in addition to other unhealthy practices such as unsupervised screen hours, irregular and unhealthy food habits, reduced outdoor activities, and peer group interaction, the positive effects of increased sleep duration were probably not registered.

Future direction

COVID-19 emerged with immense emotional and physical challenges. Culmination of several negative factors associated with COVID-19 overpowered the positive effects of increased sleep duration during this lockdown. It increased the responsibilities of our policymakers, researchers, and educationalists to provide feasible platform and formulate requisite plans, so that each individual including adolescents overcomes through them comfortably. COVID-19 pandemic is still on with lots of uncertainties about future. Reopening of schools will neutralize the negative effects, and carrying forward the observation of improvement in sleep duration during physical closure of schools may improve mood as well as performance related to sleep lack. A positive attitude with regular sleep routines, physical activity and mingling with the peers and support from the parents and teachers will help in reduction of stress, depression and anxiety, improving their mood as well as performance. Thus, a modest way with slight relaxation in sleep–wake cycle along with optimistic environment will help adolescents not only to cope up better during this pandemic but also in future.

Ethics statement

This article is being submitted as perspective, so it did not need ethical consideration.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. Available from: https://www.ncbi.nlm.nih.gov/books/NBK19960/ doi: 10.17226/11617. [Last accessed on 2014 Jan 06].
2.	Zhang M, Tillman DA, An SA. Global prevalence of sleep deprivation in students and heavy media use. Educ Inf Technol 2017;22:239-54.
3.	Singh R, Suri JC, Sharma R, Suri T, Adhikari T. Sleep pattern of adolescents in a school in Delhi, India: Impact on their mood and academic performance. Indian J Pediatr 2018;85:841-8.
4.	Talbot LS, McGlinchey EL, Kaplan KA, Dahl RE, Harvey AG. Sleep deprivation in adolescents and adults: Changes in affect. Emotion 2010;10:831-41.
5.	Guessoum SB, Lachal J, Radjack R, Carretier E, Minassian S, Benoit L, et al. Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatry Res 2020;291:113264.
6.	Johnson EO, Roth T, Breslau N. The association of insomnia with anxiety disorders and depression: Exploration of the direction of risk. J Psychiatr Res 2006;40:700-8.
7.	Roberts RE, Duong HT. The prospective association between sleep deprivation and depression among adolescents. Sleep 2014;37:239-44.
8.	Fredriksen K, Rhodes J, Reddy R, Way N. Sleepless in Chicago: Tracking the effects of adolescent sleep loss during the middle school years. Child Dev 2004;75:84-95.
9.	Curcio G, Ferrara M, De Gennaro L. Sleep loss, learning capacity and academic performance. Sleep Med Rev 2006;10:323-37.
10.	Available from: https://health.gov/healthypeople/objectives-and-data/about-objectives/healthy-people-2030-objectives-and-measures. [last accessed on 05/04/2021].
11.	Carskadon MA, Acebo C, Jenni OG. Regulation of adolescent sleep: Implications for behavior. Ann N Y Acad Sci 2004;1021:276-91.
12.	Pelayo RP. Prevalence of delayed sleep phase syndrome among adolescence. Sleep Res 1988;17:391.
13.	Weitzman ED, Czeisler CA, Coleman RM, Spielman AJ, Zimmerman JC, Dement W, et al. Delayed sleep phase syndrome. A chronobiological disorder with sleep-onset insomnia. Arch Gen Psychiatry 1981;38:737-46.
14.	Clara MI, Allen Gomes A. An epidemiological study of sleep-wake timings in school children from 4 to 11 years old: Insights on the sleep phase shift and implications for the school starting times' debate. Sleep Med 2020;66:51-60.
15.	Singh R, Sharma R, Suri JC, Das S. Impact of sleep patterns on mood and academic performance of medical students. Indian J Sleep Med 2009;4:61-7.
16.	National Sleep Foundation. Sleep in America Poll; 2006. Available from: http://www.sleepfoundation.org.” last accessed 15/06/2021.
17.	Roberts RE, Roberts CR, Chen IG. Functioning of adolescents with symptoms of disturbed sleep. J Youth Adolesc 2001;30:1-18.
18.	Wolfson AR, Carskadon MA. Sleep schedules and daytime functioning in adolescents. Child Dev 1998;69:875-87.
19.	Hill P. Sleep disturbances in depression and anxiety: Issues in childhood and adolescence. J Psychosom Res 1994;38 Suppl 1:61-7.
20.	Johnson EO, Breslau N. Sleep problems and substance use in adolescence. Drug Alcohol Depend 2001;64:1-7.
21.	Singh R, Sharma R, Suri JC, Kapoor R, Das S. Effect of early school timings on mood and performance of students. Indian J Sleep Med 2010;5.3,88-94.
22.	Pradhan RK, Sinha N. Impact of commuting distance and school timing on sleep of school students. Sleep Biol Rhythms 2017;15:153-8.
23.	Widome R, Berger AT, Iber C, Wahlstrom K, Laska MN, Kilian G, et al. Association of delaying school start time with sleep duration, timing, and quality among adolescents. JAMA Pediatr 2020;174:697-704.
24.	Gruber R, Saha S, Somerville G, Boursier J, Wise MS. The impact of COVID-19 related school shutdown on sleep in adolescents: A natural experiment. Sleep Med 2020;76:33-5.
25.	Zhou SJ, Zhang LG, Wang LL, Guo ZC, Wang JQ, Chen JC, et al. Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. Eur Child Adolesc Psychiatry 2020;29:749-58.
26.	Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet 2020;395:945-7.
27.	Brazendale K, Beets MW, Weaver RG, Pate RR, Turner-McGrievy GM, Kaczynski AT, et al. Understanding differences between summer vs. school obesogenic behaviors of children: The structured days hypothesis. Int J Behav Nutr Phys Act 2017;14:100.
28.	Allabadi H, Dabis J, Aghabekian V, Khader A, Khammash U. Impact of COVID-19 lockdown on dietary and lifestyle behaviours among adolescents in Palestine. Dynam Hum Health 2020;7:2170.
29.	Dutta K, Mukherjee R, Sen D, Sahu S. Effect of COVID-19 lockdown on sleep behavior and screen exposure time: An observational study among Indian school children. Biol Rhythm Res 2020;16:1-2.